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Review
. 2020 Dec;28(6):430-434.
doi: 10.1097/MOO.0000000000000668.

Predictors of surgical management for paediatric orbital subperiosteal abscesses

Swathi Appachi  1   2 , Joshua R Bedwell  1   2
Affiliations
Review

Predictors of surgical management for paediatric orbital subperiosteal abscesses

Swathi Appachi et al. Curr Opin Otolaryngol Head Neck Surg. 2020 Dec.

Abstract

Purpose of review: Many paediatric orbital subperiosteal abscesses (SPA) are effectively managed conservatively with systemic antibiotics, but surgical drainage is required in some patients. This review aims to summarize the current literature to determine predictors of surgical intervention.

Recent findings: Nearly all the data regarding this topic come from analysis of retrospective case series. There is consensus that large volume SPAs require surgical drainage; however, the cutoff for volume differs between studies. Proptosis more than 5 mm, superior location of SPA and patient age more than 9 years are also all factors that may predispose towards surgical treatment.

Summary: A conservative approach may be trialled in younger patients with medial, smaller volume SPAs. Larger volume SPA, presence of proptosis, superior location of SPA and patient age more than 9 years should lower the threshold for considering surgical intervention. Given that many studies have been retrospective, future studies should be prospective and specifically aim to determine a cutoff for SPA volume.

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References

    1. Adil EA, Muir ME, Kawai K, et al. Pediatric subperiosteal abscess secondary to acute sinusitis: a systematic review and meta-analysis. Laryngoscope 2020; [Epub ahead of print].
    1. Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope 1970; 80:1414–1428.
    1. Souliere CR, Antoine GA, Martin MP, et al. Selective nonsurgical management of subperiosteal abscess of the orbit: computerized tomography and clinical course as indication for surgical drainage. Int J Pediatr Otorhinolaryngol 1990; 19:109–119.
    1. Bedwell JR, Choi SS. Medical versus surgical management of pediatric orbital subperiosteal abscesses. Laryngoscope 2013; 123:2337–2338.
    1. Quintanilla-Dieck L, Chinnadurai S, Goudy SL, Virgin FW. Characteristics of superior orbital subperiosteal abscesses in children: superior orbital subperiosteal abscesses. Laryngoscope 2017; 127:735–740.

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